Skip to main content

Advertisement

SpringerLink
Log in

Long-term safety of high-dose whole pelvic IMRT for high-risk localized prostate cancer through 10-year follow-up

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the long-term efficacy and safety of whole pelvic intensity-modulated radiation therapy with a simultaneous-integrated boost (WP-SIB-IMRT) for locally advanced prostate cancer (LAPCa).

Methods

All patients with cT3–4N0M0 prostate cancer treated with WP-SIB-IMRT between February 2006 and September 2009 at our institution were analyzed retrospectively. The prescribed dose was 78 Gy to the prostate and 58.5 Gy to the prophylactic pelvic lymph nodal area in 39 fractions delivered using the simultaneous-integrated boost technique. All patients received short-term neoadjuvant androgen-deprivation therapy alone (median 8.3 months). Propensity-score matching (PSM) analysis was performed to evaluate the additional benefit of prophylactic whole pelvic radiation therapy (WPRT), using the cohort of 203 LAPCa patients treated with prostate-only IMRT (PO-IMRT).

Results

In total, 47 consecutive patients were analyzed. The median estimated risk of pelvic lymph node involvement was 57.5%. The median follow-up period was 10.5 years. The 10 year prostate cancer-specific survival and biochemical failure (BF) rates were 92.2 and 54.8%, respectively. The 10 year cumulative incidence rates of ≥ grade 2 late genitourinary and gastrointestinal toxicities were 21.6 and 17.2%, respectively. From a total of 250 patients, PSM analysis identified 76 patients with similar characteristics, and no significant difference in BF rates was observed between WP-SIB-IMRT and PO-IMRT cohorts (p = 0.261).

Conclusions

WP-SIB-IMRT for LAPCa was safe over long-term observation, although no clear benefit of WPRT was observed among our small and highly selected cohort. Regarding the additional efficacy of WPRT, further investigations are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. National Comprehensive Cancer network (2019) NCCN Guidelines; prostate cancer version 2.2019. In: The category of prostate cancer. https://www.nccn.org/guidelines/category_1 Accessed April 17 2019

  2. Asbell SO, Martz KL, Shin KH et al (1998) Impact of surgical staging in evaluating the radiotherapeutic outcome in RTOG #77-06, a phase III study for T1BN0M0 (A2) and T2N0M0 (B) prostate carcinoma. Int J Radiat Oncol Biol Phys 40(4):769–782. https://doi.org/10.1016/s0360-3016(97)00926-7

    Article  CAS  PubMed  Google Scholar 

  3. Pommier P, Chabaud S, Lagrange JL et al (2016) Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Update of the long-term survival results of the GETUG-01 randomized study. Int J Radiat Oncol Biol Phys 96(4):759–769. https://doi.org/10.1016/j.ijrobp.2016.06.2455

    Article  PubMed  Google Scholar 

  4. Roach M, Moughan J, Lawton CAF et al (2018) Sequence of hormonal therapy and radiotherapy field size in unfavourable, localised prostate cancer (NRG/RTOG 9413): long-term results of a randomised, phase 3 trial. Lancet Oncol 19(11):1504–1515. https://doi.org/10.1016/s1470-2045(18)30528-x

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tharmalingam H, Choudhury A, Van Herk M et al (2019) New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer. Nat Rev Urol 16(9):523–538. https://doi.org/10.1038/s41585-019-0213-3

    Article  PubMed  Google Scholar 

  6. Di Muzio NG, Fodor A, Noris Chiorda B et al (2016) Moderate hypofractionation with simultaneous integrated boost in prostate cancer: long-term results of a phase I-II study. Clin Oncol (R Coll Radiol) 28(8):490–500. https://doi.org/10.1016/j.clon.2016.02.005

    Article  Google Scholar 

  7. Magli A, Moretti E, Tullio A et al (2018) Hypofractionated simultaneous integrated boost (IMRT-SIB) with pelvic nodal irradiation and concurrent androgen deprivation therapy for high-risk prostate cancer: results of a prospective phase II trial. Prostate Cancer Prostatic Dis 21(2):269–276. https://doi.org/10.1038/s41391-018-0034-0

    Article  CAS  PubMed  Google Scholar 

  8. Pervez N, Boychak A, Drodge CS et al (2017) Late toxicity and outcomes in high-risk prostate cancer patients treated with hypofractionated IMRT and long-term androgen suppression treatment. Am J Clin Oncol 40(2):200–206. https://doi.org/10.1097/COC.0000000000000133

    Article  CAS  PubMed  Google Scholar 

  9. Franzese C, Fogliata A, D’Agostino GR et al (2017) Moderate hypofractionated radiotherapy with volumetric modulated arc therapy and simultaneous integrated boost for pelvic irradiation in prostate cancer. J Cancer Res Clin Oncol 143(7):1301–1309. https://doi.org/10.1007/s00432-017-2375-9

    Article  CAS  PubMed  Google Scholar 

  10. Dearnaley D, Griffin CL, Lewis R et al (2019) Toxicity and patient-reported outcomes of a phase 2 randomized trial of prostate and pelvic lymph node versus prostate only radiotherapy in advanced localised prostate cancer (PIVOTAL). Int J Radiat Oncol Biol Phys 103(3):605–617. https://doi.org/10.1016/j.ijrobp.2018.10.003

    Article  PubMed  PubMed Central  Google Scholar 

  11. Murthy V, Maitre P, Kannan S et al (2021) Prostate-only versus whole-pelvic radiation therapy in high-risk and very high-risk prostate cancer (POP-RT): outcomes from phase III randomized controlled trial. J Clin Oncol. https://doi.org/10.1200/JCO.20.03282

    Article  PubMed  Google Scholar 

  12. Koerber SA, Winter E, Katayama S et al (2019) Elective node irradiation with integrated boost to the prostate using helical IMRT-clinical outcome of the prospective PLATIN-1 trial. Front Oncol 9:751. https://doi.org/10.3389/fonc.2019.00751

    Article  PubMed  PubMed Central  Google Scholar 

  13. Reis Ferreira M, Khan A, Thomas K et al (2017) Phase 1/2 dose-escalation study of the use of intensity modulated radiation therapy to treat the prostate and pelvic nodes in patients with prostate cancer. Int J Radiat Oncol Biol Phys 99(5):1234–1242. https://doi.org/10.1016/j.ijrobp.2017.07.041

    Article  PubMed  PubMed Central  Google Scholar 

  14. Roach M 3rd, Marquez C, Yuo HS et al (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28(1):33–37. https://doi.org/10.1016/0360-3016(94)90138-4

    Article  PubMed  Google Scholar 

  15. Aizawa R, Takayama K, Nakamura K et al (2019) Ten-year outcomes of high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer with unfavorable risk: early initiation of salvage therapy may replace long-term adjuvant androgen deprivation. Int J Clin Oncol 24(10):1247–1255. https://doi.org/10.1007/s10147-019-01478-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO phoenix consensus conference. Int J Radiat Oncol Biol Phys 65(4):965–974. https://doi.org/10.1016/j.ijrobp.2006.04.029

    Article  PubMed  Google Scholar 

  17. Aizawa R, Takayama K, Nakamura K et al (2021) Increased risk of disease progression in younger men: analysis of factors predicting biochemical failure and castration-resistant prostate cancer after high-dose intensity-modulated radiation therapy for nonmetastatic prostate cancer. Urol Oncol 39(2):131 e139-131 e115. https://doi.org/10.1016/j.urolonc.2020.09.026

    Article  Google Scholar 

  18. Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10(2):150–161. https://doi.org/10.1002/pst.433

    Article  PubMed  Google Scholar 

  19. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48(3):452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  Google Scholar 

  20. Murthy V, Maitre P, Bhatia J et al (2020) Late toxicity and quality of life with prostate only or whole pelvic radiation therapy in high risk prostate cancer (POP-RT): a randomised trial. Radiother Oncol 145:71–80. https://doi.org/10.1016/j.radonc.2019.12.006

    Article  CAS  PubMed  Google Scholar 

  21. Han S, Woo S, Kim YJ et al (2018) Impact of (68)Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur Urol 74(2):179–190. https://doi.org/10.1016/j.eururo.2018.03.030

    Article  CAS  PubMed  Google Scholar 

  22. Saga T, Nakamoto Y, Ishimori T et al (2019) Initial evaluation of PET/CT with (18) F-FSU-880 targeting prostate-specific membrane antigen in prostate cancer patients. Cancer Sci 110(2):742–750. https://doi.org/10.1111/cas.13911

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tharmalingam H, Tsang Y, Choudhury A et al (2020) External beam radiation therapy (EBRT) and high-dose-rate (HDR) brachytherapy for intermediate and high-risk prostate cancer: the impact of EBRT volume. Int J Radiat Oncol Biol Phys 106(3):525–533. https://doi.org/10.1016/j.ijrobp.2019.09.044

    Article  CAS  PubMed  Google Scholar 

  24. Sandler KA, Cook RR, Ciezki JP et al (2020) Prostate-only versus whole-pelvis radiation with or without a brachytherapy boost for Gleason grade group 5 prostate cancer: a retrospective analysis. Eur Urol 77(1):3–10. https://doi.org/10.1016/j.eururo.2019.03.022

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Ryo Ashida for his assistance with statistics and data-checking of the analysis.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan

    Rihito Aizawa, Kiyonao Nakamura, Yoshiki Norihisa, Takashi Ogata & Takashi Mizowaki

  2. Department of Radiation Oncology, Bellland General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka, 599-8247, Japan

    Yoshiki Norihisa

  3. Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan

    Takahiro Inoue, Toshinari Yamasaki, Takashi Kobayashi, Shusuke Akamatsu & Osamu Ogawa

  4. Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan

    Takahiro Inoue

  5. Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan

    Toshinari Yamasaki

Authors
  1. Rihito Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiyonao Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiki Norihisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Ogata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takahiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshinari Yamasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shusuke Akamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Osamu Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takashi Mizowaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takashi Mizowaki.

Ethics declarations

Conflict of interest

The authors made no disclosures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aizawa, R., Nakamura, K., Norihisa, Y. et al. Long-term safety of high-dose whole pelvic IMRT for high-risk localized prostate cancer through 10-year follow-up . Int J Clin Oncol 26, 2113–2122 (2021). https://doi.org/10.1007/s10147-021-02002-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-021-02002-x

Keywords

Search

Navigation